5 Best Medical Aids in South Africa Cover Breast Reduction
Do Medical Aids Cover Breast Reduction in South Africa revealed.
We verified the best medical aids in South Africa that cover breast reductions.
This is a complete guide to the best medical aids that cover breast reduction in South Africa.
In this in-depth guide you’ll learn:
- What is a Breast Reduction?
- Which medical aids cover breast reduction surgery in South Africa?
- Do you get free breast reduction surgery in South Africa?
- Which medical aids cover plastic surgery in South Africa?
So if you’re ready to go “all in” with the best medical aid that covers breast reduction in South Africa, this guide is for you.
Let’s dive right in…
Best Medical Aids in South Africa Cover Breast Reduction (2023)
Bonitas Medical Aid – Overall, Best Medical Aid that Covers Breast Reduction in South Africa
Discovery Medical Aid – Best Customer Service Medical Aid
Momentum Health – Best Pay-As-You-Go Private Healthcare
Fedhealth Medical Scheme – Broadest Range of Low-Cost Medical Aid Plans
BestMed Medical Aid – Top Extensive Medical Protection in South Africa
Introduction to Medical Aid Support & Coverage of Breast Reduction
👉 In recent years, breast reduction has emerged as one of South Africa’s most sought-after forms of cosmetic surgery, but breast reductions and other forms of cosmetic surgery are typically not covered by medical aids unless the surgeon can demonstrate that the procedure is absolutely essential to the patient’s health.
👉 In South Africa, the majority of medical aids for breast reduction surgeries fall into one of these three categories: medical aids that do not cover the cost of the procedure, medical aids that cover the cost of the procedure in full or in part, and medical aids that make decisions on a case-by-case basis after consulting with clinical experts.
👉 In most cases, breast reduction surgery is not covered by any of the available medical aids. Every medical aid has its own set of protocols and requirements to follow. Any procedure that involves plastic surgery in South Africa must adhere to stringent guidelines for it to be covered by insurance.
👉 A significant number of women and medical professionals are dissatisfied with the red tape that medical aids have imposed on a variety of plastic surgery procedures, including breast reductions, to pay for them. Breast reductions, in the opinion of these women and their doctors, should be regarded as procedures that are required for medical treatment, regardless of whether or not medical aids share their perspectives on the matter.
👉 During a breast reduction procedure in plastic surgery, the surgeon will remove some of the patient’s excess breast tissue. The stringent guidelines that medical aids have for procedures in plastic surgery that are both cosmetically desirable and medically necessary, will determine as to whether or not your medical aid will cover the cost of this procedure.
👉 A petition that was started by Breast Reduction Support SA and is addressed to the Council of Medical Aids and the department of health has received over 50,000 signatures from individuals who are interested in having their voices heard.
👉 When it comes to the vast majority of medical assistance programmes, providing sufficient financial justification for the cost of plastic surgery procedures like breast reduction is essential. In addition, even if the plan states that it will pay for the breast reduction surgery, you may still be required to provide a detailed justification for the medical necessity of the procedure. This justification will include relevant images, doctor’s reports, and your medical record.
👉 Women who have extra breast tissue often suffer from a variety of unpleasant physical symptoms, including pain in the back and neck, wheezing, and chest tightness.
👉 The operation is typically carried out under general anaesthesia, and its duration ranges anywhere from two to three hours on average. Breast reduction surgery can cost anywhere from R 55,000 to R 62,000. This price range is determined by the surgeon as well as the length of the procedure. The cost of anaesthesia, the fees charged by the hospital, the fees charged for consultation, and any fees charged by the assistant or surgeon are all included.
👉 Because all medical aid schemes in South Africa take a similar stance on breast reduction surgery, it appears to be a controversial point at this time.
👉 If you are a woman considering clinically indicated breast reduction surgery, take heart in the fact that doctors from APRASSA (Association of Plastic, Reconstructive, and Aesthetic Surgeons of Southern Africa) are advocating for you.
READ more about Breast Uplift Procedure (Mastopexy): Enhancing Form and Confidence
5 of the Best-Known Medical Aids in South Africa & Their Coverage of Breast Reduction
👉 In most cases, payment for plastic surgery will only be covered by a medical aid plan if doing so is regarded as being required for medical reasons.
👉 If you and your attending physician can verify that a procedure is both medically necessary and will either repair or maintain normal body function, then the majority of medical aid schemes in South Africa will cover all or part of the costs associated with the surgical procedure, depending on the level of cover you have purchased.
👉 For instance, medical aids may provide coverage for the costs of rhinoplasty to correct a deviated septum, breast reduction surgery to alleviate postural backache or stress on the spine, or breast reconstruction surgery after a full or partial mastectomy.
👉 Even in cases where medical aid programmes are willing to cover the costs of cosmetic surgery, there are still many restrictions in place.
Breast medical procedures in South Africa:
👉 You will be required to provide a comprehensive justification for the necessity of the surgery, which should include pertinent photographs, reports from doctors, and medical records.
👉 The stance of 5 well-known medical aids in South Africa is discussed below.
1. Bonitas Medical Aid
👉 Bonitas Medical Aid has been in operation for several decades, during which time it has developed a solid comprehension of the South African private healthcare market.
👉 Its team of professionals is continually looking into new ways to ensure that members are provided with health care that is both inexpensive and of high quality. Keeping up with technological advances, managing treatment in such a way that lifestyle diseases are detected before they develop into chronic conditions, and negotiating better rates are all part of its development and service delivery.
👉 In addition, the company’s finances are sound, it has a sufficient amount of money set aside as a buffer, and its key indications of fiscal health are strong.
👉 Members are eligible to join the Sanlam Reality rewards programme if they are enrolled in the Bonitas medical aid programme. You’ll be able to take advantage of a gym benefit at Virgin Active that is designed in such a way that the more you work out, the more cash rewards you’ll be eligible for.
Who Manages Bonitas Medical Aid?
👉 Bonitas is run by a management team with a lot of experience and an independent Board of Trustees made up of professionals from the health, legal, financial, and business fields – and who are not members.
👉 Knowing that one size doesn’t fit all, Bonitas offers a wide variety of plans so that any family can find one that fits their needs perfectly.
👉 The plans are easy to understand and use while helping the customer to get the most out of their benefits.
Savings Plan Options
👉 These option plans are top of the range and give members a set amount that they can use in a way they prefer for out-of-hospital costs like visits to doctors, optometry, and dentistry. They also cover you during your stays in the hospital and give you extra benefits for maternity, wellness, and preventative care.
👉 Members can choose from the following:
➡️ BonComprehensive, is a first-class savings plan that offers ample savings, an above-threshold benefit and the best extensive hospital cover.
➡️ BonClassic, a savings option that offers a wide range of in and out-of-hospital medical benefits.
➡️ BonComplete, a savings option that offers the most generous savings, an above-threshold benefit and excellent hospital cover.
➡️ BonSave, a savings option that offers sufficient savings to use for medical expenses and extensive hospital cover.
➡️ BonFit Select, a savings plan that offers essential hospital cover and basic cover for day-to-day medical needs.
Traditional Option Plans
👉 These more traditional plans give an overall day-to-day coverage subject to limits for GP and specialist consultations, acute and over-the-counter medicine, X-rays and blood tests and other out-of-hospital medical expenses.
➡️ Primary Option – a traditional option that offers modest day-to-day benefits and hospital cover.
➡️ Primary Select Option – a traditional option that offers modest day-to-day benefits and hospital cover through a set network of quality providers.
➡️ Standard Option – a traditional option that offers ample day-to-day benefits and comprehensive hospital cover.
➡️ Standard Select Option – a traditional option that uses a network of quality providers to offer good day-to-day benefits and hospital cover.
Option Plans in the Edge Category
👉 The Edge category gives members access to day-to-day benefits like unlimited GP consultations, layers of virtual care, dental and optical consultations, a private hospital network and more.
👉 The options include the following:
➡️ BonStart – an option that is designed for economically active singles with a drive to succeed, who live in the larger metros.
➡️ BonStart Plus – an option that is designed for young, economically active couples, living in the larger metros, and who are thinking of expanding their family.
Hospital Cover Plans
👉 These plans cover members only for emergency and planned procedures in hospitals with limited access to a few additional benefits for wellness and preventative care.
➡️ BonEssential Select – a hospital plan that uses a good quality provider network to offer comprehensive hospital benefits and a few value-added benefits.
➡️ BonEssential Plan – a hospital plan that offers comprehensive hospital benefits with several additional value-added benefits.
➡️ Standard Hospital Plan – a plan that offers general hospital coverage to members, as well as a few value-added benefits.
👉 The BonCap Option is an income-based entry-level plan that offers only basic day-to-day benefits and hospital cover when a member uses the set network of doctors, providers and hospitals.
Breast Reduction Benefits Available from Bonitas Medical Aid
👉 Breast reduction surgery that has a medical justification and is performed within Bonitas Medical Aid’s guidelines for what constitutes a medically required procedure will be covered by the fund.
👉 Furthermore, even if Bonitas Medical Aid indicates that it will cover the breast reduction surgery, you may still be required to provide a detailed justification for the procedure’s medical necessity. This will include relevant images, doctor’s reports, and your medical record.
👉 After a complete or partial mastectomy, breast reconstruction is likely to be covered by Bonitas if the procedure falls under the prescribed minimum benefits as set out by the government.
How Much Are Bonitas Medical Aid Monthly Premiums?
👉 Bonitas monthly contributions start at R 2 033 for a Principal Member, R 1 555 for a spouse/adult dependant and R 596 per child (max 3) on the BonEssential Hospital Plan and go up to R 8 217 for a main member, R7 749 for additional adult, and R 1 672 for a child for the BonComprehensive plan that offers abundant savings, an above threshold benefit and extensive hospital cover.
What Is the Waiting Period for Bonitas Medical Aid Benefits?
👉 The minimum general waiting period for Bonitas medical aid is three months for all benefits. Some plans, however, have a waiting period of 12 months, especially regarding a pre-existing condition.
👉 Pregnancy is considered a pre-existing condition; therefore it is excluded from all benefits for the first 12 months of scheme membership.
How to Claim Breast Reduction Benefits from Bonitas
👉 You can send in your claim in the following ways:
➡️ Email your claims to [email protected].
➡️ Post your claims to Bonitas Claims Department, PO Box 74, Vereeniging, 1930.
➡️ Submit your claims in person at one of the walk-in centres.
👉 Follow these simple steps to get your claims paid quickly:
➡️ Ensure your banking details are correct for refunds by electronic transfer (EFT) into your bank account
➡️ Make sure that your account and receipt show your name and initials, membership number, treatment date, the name of the patient as shown on your membership card, the amount charged and ICD-10 code.
Bonitas Contact Details
34 Melrose Blvd, Birnam, Johannesburg, 2196
Phone for General Queries: 0860002108
Email: [email protected]
Email: [email protected]
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2. Discovery Medical Aid
👉 Discovery Health Medical Scheme (DHMS) is a registered open medical scheme, which means that anyone can join as long as they adhere to the Scheme’s rules and regulations. It is most likely the largest open medical scheme in South Africa.
👉 The Discovery Health Medical Scheme provides more than 20 different choices for health plans, each of which includes limitless coverage for private hospital care as well as a range of other benefits that can be tailored to your preferences and your financial situation.
👉 You will have access to a wide variety of benefits, care programmes, and services that will ensure that you can receive the highest quality medical care whenever it is required, and your doctor will be reimbursed accordingly.
👉 Discovery asserts that its monthly premiums payable by members are, on average, much lower than the contributions that other South African medical schemes demand for the same level of coverage.
👉 Vitality is the company’s wellness initiative in which members are invited to participate. The programme provides a range of incentives and benefits to inspire members to lead a healthy lifestyle.
Who Manages Discovery Medical Aid?
👉 The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes.
👉 The Scheme is owned by its members, and it is run by an independent Board of Trustees. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Discovery Medical Aid Option Plans
👉 Discovery offers a wide variety of option plans to members, that range from the most comprehensive private healthcare cover to affordable basic plans where members can get cost-effective private healthcare cover when they make use of a set but extensive network of providers.
👉 Members can choose from the following health plan options:
👉 The top Executive Plan offers customers the most extensive cover for in-hospital and day-to-day benefits, as well as extended chronic medicine cover and an unlimited Above Threshold Benefit.
👉 This series of plans provide comprehensive day-to-day cover and in-hospital cover to members, as well as extended chronic medicine cover and an unlimited Above Threshold Benefit.
👉 Plans in this series offer general, cost-effective in-hospital cover, an essential chronic medicine cover and day-to-day benefits with a limited Above Threshold Benefit.
👉 The saver series provide more economical options that still provide in-hospital cover, essential chronic medicine cover and day-to-day benefits through a Medical Savings Account.
👉 This is a real value-for-money series of hospital plans. They provide unlimited private hospital cover and essential cover for chronic medicine, but members have no access to day-to-day coverage.
👉 These plans provide the very affordable, cost-effective in-hospital cover, an essential chronic medicine cover plus limited day-to-day benefits if you make use of providers in the specified network.
👉 This series of basic plans offer the most affordable medical cover providing members use service providers for both in-hospital and out-of-hospital treatment from a specified network.
Breast Reduction Benefits under Discovery Medical Aid Option Plans
👉 Discovery Medical aid provide “medical support for the conservative management of macromastia”, as stated in its rules.
👉 DHMS maintain that it has funded funds breast reduction surgery for members on its higher plans who have a specific clinical need for these procedures for many years.
👉 The medical aid however does not pay for this kind of surgery where it is solely for aesthetic purposes. With other medical aids, it considers all cosmetic surgery as “a General Scheme Exclusion for open schemes in South Africa”.
👉 It is interesting though that plastic surgeons find that breast reduction is seldom done for cosmetic reasons. In the majority of cases, and despite what the schemes may say, it is needed by the candidate due to health reasons.
👉 If a member can prove a medical necessity, Discovery says the reduction surgery can be funded under its Executive and Comprehensive plans (except Classic Smart Comprehensive plan), but only if the patient falls within the fund’s selection criteria.
How Much Are Discovery Medical Aid Monthly Premiums?
👉 Monthly premiums start from R930 per member for the Keycare Series with medical cover for both in-hospital and out-of-hospital treatment by providers in a specified network and goes up to R8 298 per member for the Executive Plan with extensive cover for in-hospital and day-to-day benefits, extended chronic medicine cover, and unlimited Above Threshold Benefit.
What Is the Waiting Period for Discovery Medical Aid’s Benefits?
👉 Discovery Health Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim for Discovery Medical Aid Benefits
👉 You can submit a claim fast and easily in the following ways:
➡️ Scan and upload your claims on the website.
➡️ Scan and email your claims to [email protected].
➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
➡️ You can also submit your claims by post.
Discovery Medical Aid Contact Details
1 Discovery Pl, Sandhurst, Sandton,
PO Box 784262, Sandton, 2146
Phone: 0860 99 88 77
EMAIL: [email protected]
3. Momentum Health
👉 Momentum Medical Scheme is an open medical aid that does not generate a profit and is registered in accordance with the Medical Schemes Act 131 of 1998, in its revised form.
👉 Momentum is one of the leading open medical plans in South Africa, and it is managed by one of the country’s largest and most reputable firms that provide healthcare solutions.
👉 When its members make decisions that are better for their health, they are rewarded. Members who have the Evolve, Custom, Incentive, Extender, or Summit Option have access to Multiply Inspire at no additional cost.
👉 If a member upgrade to Multiply Inspire Plus, the person will be eligible to earn up to R1,500 in HealthReturns per adult per month.
👉 Members of Momentum Health4Me and the Ingwe Option are eligible to receive a complimentary subscription to Multiply Engage. They have the option to upgrade to Multiply Engage Plus in order to receive increased advantages and prizes.
👉 At the Annual General Meetings that are held each year, new trustees for the Momentum Medical Scheme are chosen. There are several people with significant experience and expertise in a range of professions represented on the Board of Trustees. These fields include medicine, accounting, and the law, among others.
Who Manages Momentum Health?
👉 Momentum Health Solutions is a wholly-owned subsidiary of Momentum Metropolitan Life Limited.
👉 Each year its Board of Trustees is elected at an Annual General Meetings and includes several individuals with substantial experience and skills in a variety of medical, accounting and legal fields.
👉 Momentum Medical Scheme gives members a choice between a wide range of medical insurance options and benefits, including 6 medical aid plans.
👉 This option gives entry-level medical cover that is accessible to more people due to its affordability. A member can get treatment at any hospital, the Ingwe network of private hospitals, or State hospitals.
👉 This option gives unlimited private hospital cover from any provider and a chronic cover for 36 conditions is available, with day-to-day benefits up to about R30 000 per beneficiary per year are covered.
👉 This option gives hospital cover and chronic cover from any or associated service providers.
👉 Day-to-day expenses are paid from a dedicated medical savings account funded by 25% of your contributions. You get an Extended Cover benefit once you have reached a set threshold.
👉 With this option members get extensive hospital and chronic cover from any or associated service providers. Day-to-day expenses are covered by a dedicated medical savings account that is funded by 10% of a member’s monthly contributions.
👉 The Custom option provides comprehensive hospital and chronic cover from any or associated providers. You can choose to go for treatment at any hospital but will save on your contribution by using a specific private hospital listed as part of an associated network.
👉 This option provides cover for hospitalisation from the Evolve Network of private hospitals with no overall annual limit and members get access to 2 virtual doctors’ consultations. Additional day-to-day benefits are subject to HealthSaver+.
Breast Reduction Benefits under Momentum Health’s Option Plans
👉 Momentum Health has acknowledged the issue of breast reduction coverage and admitted that their benefits need to be reviewed.
👉 According to its management breast reductions pose more difficult decisions than in most other procedures the fund covers.
👉 While the Scheme Rules and clinical policies have the important role to play in protecting the collective members of a medical scheme and funds available, the plight of breast reduction candidates, where a substantive link between breast size, back pain and ultimately spinal surgery, needs attention.
👉 The aid aims to ensure healthcare cover for all members when they need it, but finds it challenging to assess when there is an evidence-based medical need for surgical intervention, or when members and providers may use certain medical codes to obtain authorisation for surgery where limited evidence is available to support its clinical efficacy.
How Much Are Momentum Health Monthly Premiums?
👉 Momentum monthly premiums start at R1 539 for the main member on the Evolve Option and go up to R12 345 for the main member on the Summit Option.
What Is the Waiting Period for Momentum Health’s Benefits?
👉 The general waiting period is 3 months, but since pregnancy is considered a pre-existing condition, it is excluded from all benefits for the first 12 months of scheme membership.
How to Claim Momentum Health Benefits
👉 You can submit a claim in several ways:
➡️ Use the Momentum App
➡️ Use the web chat facility in the bottom left corner.
➡️ Send an email to [email protected] or send normal mail to PO Box 2338, Durban, 4000
👉 To make sure your claim is processed quickly and accurately, include the following information:
➡️ Membership number.
➡️ Principal member’s surname, initials, and first name.
➡️ Patient’s surname, initials, and first name.
➡️ Date of treatment.
➡️ Amount charged.
➡️ ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
➡️ Service provider’s name and practice number.
➡️ Proof of payment if you’ve paid the claim out of your own pocket.
Momentum Health Contact Details
201 Umhlanga Ridge Blvd, Cornubia, Blackburn
PO Box 2338
Call or WhatsApp – 0860 11 78 59
👉 Fedhealth is one of the oldest health insurance companies in South Africa.
👉 It was started in 1936 as the Reef Medical Scheme. Having been around for a long time it is financially stable with a solvency ratio of 25.75%, a global credit rating of -AA, and around 200 000 members.
👉 Since 1936, Fedhealth has been taking care of the health of South Africans and worked hard to offer affordable health care that is also of high quality.
👉 Fedhealth is also known for its unique benefits paid by Risk, which help members get more out of their regular benefits.
👉 With its flexiFED plans, members can choose the exact type of medical coverage they need, no matter where they are in life. And with the GRID and Elect options for medical aid, members can save up to 25% on payments at the same time.
👉 With its virtual walk-in centre, members can make an appointment with a dedicated agent to talk about any questions that might be hard to answer.
Who Manages Fedhealth Medical Scheme?
👉 The company is still run by members for members and is always coming up with new ideas to meet the needs of people who want to take care of their health in a changing world.
Fedhealth Medical Scheme Option Plans
👉 The medical aid option plans offered by Fedhealth are designed to fit the needs, budget, and stage of life of members. They can choose from a variety of options, including coverage for the first time in their life, the advanced flexiFED options that let you build your own aid, and the maxiFED options that offer the most comprehensive medical aid coverage.
👉 The following option plans are available:
👉 Maxima PLUS – an option that offers extensive medical cover for all aspects of healthcare, including extensive in-hospital cover, chronic medicine, screening and additional benefits, a day-to-day savings portion, a Threshold benefit, and an optional hospital expense benefit.
👉 Maxima EXEC – an option that offers comprehensive all-around cover for more mature members, including in-hospital, chronic medicine, screening and additional benefits, as well as a day-to-day savings portion and Threshold benefit.
👉 FlexiFED 4 – an option that provides solid cover for mature families with older kids. Apart from the comprehensive in-hospital cover, it also offers Fedhealth Savings for unplanned medical bills and a Threshold benefit once claims have exceeded a certain level.
👉 FlexiFED 3 – an option that is suitable for young, growing families since it provides generous maternity and childhood benefits for pregnancy, birth and the active early childhood years. Members also have access to Fedhealth Savings for unforeseen medical expenses, and a Threshold Benefit that starts once claims have reached the specified level.
👉 FlexiFED 2 is a convenient family hospital plan option for young parents, with substantial maternity and childhood benefits, access to Fedhealth Savings for unexpected day-to-day medical expenses, and a Threshold Benefit that kicks in when a member’s claims have reached a certain level.
👉 FlexiFED 1 is an affordable hospital plan that provides solid medical aid coverage at an affordable premium. Members have access to Fedhealth Savings that help to cover unexpected day-to-day medical bills and a Threshold Benefit that kicks in once claims have reached the specified level.
👉 FlexiFED Savvy is a very affordable personalised, customised hospital plan for the young and healthy who just started their first jobs. It also has a day-to-day backup plan.
👉 MyFED offers affordable cover that is salary-banded for lower-income employees who was previously without medical aid.
Breast Reduction Benefits under Fedhealth Medical Scheme’s Option Plans
👉 Fedhealth management still finds it difficult to recognise a conclusive link between the size of breasts and musculoskeletal pain.
👉 The scheme currently doesn’t simply accept and fund breast reduction surgery because it causes pain, because it is a very invasive procedure with a high risk of complications. The fund, by the mouth of a spokesperson, admitted in an interview that although large breasts could be uncomfortable and even cause embarrassment, it does not follow that schemes should be obliged to fund the procedure.
👉 Fedhealth does however offer a MediVault and Wallet system that allows members the option to use allocated funds for day-to-day expenditure for this specific procedure. It boils down to an interest-free loan that the member pays off over a period of 12 months.
How Much Are Fedhealth Medical Scheme Monthly Premiums?
👉 The monthly premiums for the salary-banded myFED option is from R 1 275 per month for the main member. The maxima PLUS extensive medical cover will cost 13 122 per month per the main member.
What Is the Waiting Period for Fedhealth Scheme’s Benefits?
👉 The general waiting period for FedHealth benefits is usually three months, depending on the medical aid scheme you join. The waiting period for pre-existing conditions is 12 months.
How to Claim Benefits from Fedhealth Medical Scheme
👉 Members can submit claims using one of the following:
➡️ In the Fedhealth Family Room,
➡️ Through a WhatsApp service
➡️ On the Fedhealth Member Phone App
➡️ You may also email, fax or post the claims to email: [email protected], fax: (011) 671 3842 or post to Private Bag X3045, Randburg, 2125.
Fedhealth Medical Scheme Contact Details
Flora Centre Shop 21 and 22
Corner Conrad street and Ontdekkers Rd, Florida Glen, Johannesburg
Phone: 0861 116 016
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5. BestMed Medical Aid
👉 BestMed says that it is South Africa’s largest self-administered medical plan and the fourth-largest open medical plan in the country.
👉 The aid is proud of the fact that it hasn’t gone up by more than 10% for the past 5 years and that it has 13 structured plans for every stage of life and budget.
👉 All of its options are great for preventive health care, like contraceptives for women, vaccines for pneumonia and the flu, and more.
👉 BestMed has a history of giving its members access to a large network of healthcare providers, good value for money, and health benefits.
👉 The help gives people in South Africa access to networks of specialists and hospitals, as well as more than 4,300 family doctors.
Who Manages BestMed Medical Aid?
👉 The Executive Leadership of BestMed consists of Leo Dlamini as CEO/Principal Officer, Pieter Van Zyl as COO, Ntando Ndonga as Executive: Legal, Risk & Corporate Governance, Elmarie Jooste as Zxecutive: Corporate Relations & Wellness, Jessogan Chetty as CFO, Dr Dion Kapp as Executive: Managed Healthcare and Service Providers, and Madelein Barkhuizen as Executive: Sales & Marketing. They are supported by teams of Member Elected Trustees and Board Appointed Trustees.
👉 BestMed customers can choose between a selection of Hospital Plans, Network Plans, Savings Plans, and Comprehensive Plans.
Comprehensive Option Plans
👉 BestMed Comprehensive Plans include the following:
👉 Pace1 Comprehensive Plan that provides excellent hospital benefits with extensive day-to-day cover. It is ideal for those who want quality benefits but at an affordable price.
👉 Beat4 Comprehensive Plan is suitable for people with specific healthcare needs because it includes chronic benefits and savings.
👉 Pace2 Comprehensive Plan that gives comprehensive cover with in- and out-of-hospital benefits.
👉 Pace3 Comprehensive Plan offers comprehensive cover for members that have varied medical needs. It includes comprehensive chronic benefits and excellent cover in case of hospitalisation.
👉 Pace4 Comprehensive Plan that is suitable for members that need the comfort of extensive benefits and cover for hospital expenses due to their above-average medical costs, or because they just would like the maximum available cover. It has the added benefit of an individual medical savings account which offers extra payment flexibility.
Savings Option Plans
👉 BestMed Savings Plans include the following:
👉 Beat2 Savings Plan that offers extensive hospital cover at private hospitals and a savings account from which general day-to-day expenses are paid.
👉 Beat2 Network Savings Plan that offers extensive hospital cover at private hospitals as well as a savings account for general day-to-day expenses. This plan is associated with specific Network hospitals and service providers.
👉 Beat3 Savings Plan that offers extensive in-hospital cover as well as savings and additional benefits, including some maternity benefits.
👉 Beat3 Network Savings Plan that offers extensive in-hospital cover with savings and other benefits. This plan is associated with a network of hospitals and providers.
Network Option Plans
👉 BestMed Network Plans include the following:
👉 Rhythm1 Network Plan that offers unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for consultations with selected healthcare providers.
👉 Rhythm2 Network Plan that offers unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for consultations with selected healthcare providers. This option cover is dependent on members’ income levels.
Hospital Option Plans
👉 For Bestmed Hospital Plans members can choose between the Beat1 Network Plan which covers you at a range of network hospitals for planned and unplanned hospital stays, no matter what age you are; or the Beat1 Plan that gives unlimited cover for unplanned hospital stays.
Breast Reduction Benefits under BestMed Medical Aid’s Option Plans
👉 As with several other medical aids, providing sufficient financial justification for the cost of plastic surgery procedures like breast reduction is required. In addition, even if the plan states that it will pay for the breast reduction surgery, you may still be required to provide a detailed justification for the medical necessity of the procedure. This justification will include relevant images, doctor’s reports, and your medical record.
How Much Are BestMed Medical Aid Monthly Premiums?
👉 At the time of writing, monthly premiums for the cheapest BestMed Beat1 Network Hospital Plan started at R1 710 for a member, with an additional R1 329 for an adult dependant and R720 for a child dependant, to a maximum of 3 child dependants. Additional children join at no additional cost.
👉 The most expensive plan at the time was the Pace4 Comprehensive Plan, with monthly contributions of R9 411 per member and R9 411 per adult dependant. For a child dependant, the extra contribution was R2 205, up to 3 child dependants with additional children added as beneficiaries of the scheme at no extra cost.
What Is the Waiting Period for BestMed Medical Aid’s Benefits?
👉 There can be a general waiting period of three months or a specific waiting period of 12 months for a certain condition.
👉 Bestmed Medical Scheme will sometimes only pay a claim if it is a PMB. This can happen if you are in a waiting period or if you are getting treatment for a condition that your plan doesn’t cover.
How to Claim for Benefits from BestMed Medical Aid
👉 If your healthcare provider does not submit claims to BestMed, one must submit the original claim directly to the fund administrators.
👉 You can claim by means of the BestMed App, or by scanning and emailing your claim to them.
👉 Details that should appear on all claim documents include:
➡️ Member’s name and contact details
➡️ BestMed membership number
➡️ Patient’s details
➡️ Service provider’s name, contact details and practice number
➡️ Details of treatment, including applicable tariff and ICD-10 codes
➡️ Whether payment should be done to the service provider or the member
👉 You will receive an email confirmation when your claim is received and indexed.
BestMed Medical Aid Contact Details
Bestmed Medical Scheme, Glenfield Office Park, 361 Oberon Avenue, Faerie Glen, Pretoria,
PO Box 2297
Phone: +27 (0)86 000 2378
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Frequently Asked Questions
Can You Join a Medical Aid Just to Benefit for a Breast Reduction?
No, you cannot join a medical aid to benefit for a breast reduction. While anyone that qualifies to become a member of an aid, can join, medical aids do not necessary pay for reduction procedures.
Are There Medical Aids That Cover Breast Reduction?
Yes, there are medical aids that may, in certain circumstances, pay for breast reduction providing that the candidate can provide medical prove that it is not for cosmetic purposes.
How Much Does a Breast Reduction Cost at a Private Hospital Without Medical Aid?
Breast reduction surgery can cost anywhere from R 55 000 to R 62 000.
Does Medical Insurance Cover the Cost of Breast Reduction?
No, medical insurance does not cover the cost of breast reduction since it is often seen as a procedure done by choice.
Can You Have Medical Aid & Medical Insurance at the Same Time to Cover Breast Reduction?
You can have medical aid and medical insurance at the same time, but it will not necessarily mean that your breast reduction will be paid for.